Aggressive Vertebral Hemangioma Causing Spinal Cord Compression: Presenting a Study of Two Cases and Review of Literature

INTRODUCTION: Asymptomatic vertebral hemangiomas are common, but extension into the spinal canal causing cord compression with neurologic symptoms is rare. CASE REPORTS: Case 1:A 20-year-old male patient presented with difficulty in walking for 6 months with gradually progressive weakness of both the lower limbs. On examination, upper motor neuron signs were present in both the lower limbs with a sensory level below T8 and no bladder involvement. Magnetic resonance imaging (MRI) showed a vascular tumor arising from T6 lamina and pedicle and compressing the cord. Pre-operative computerized tomogram angiography and embolization of the tumor was done, followed by decompression, stabilization of the spine, and vertebroplasty. Postoperatively, the patient received radiotherapy. Case 2: A 71-year-old male patient presented with the recurrence of vertebral hemangioma and cord compression. He had a history of hemangioma with cord compression 13 years back, which was treated by embolization, followed by decompression and fixation. The patient had gradually improved neurologically to normal activities. He was asymptomatic till 7 months back when he noticed difficulty in walking. On examination, pyramidal signs were found to be positive. MRI revealed an expansile lesion at T7 vertebra which was causing compression of the spinal cord. Pre-operative embolization, followed by decompression, stabilization, and vertebroplasty was performed. He also received radiotherapy postoperatively. The diagnosis of benign capillary hemangioma was made after histopathological examination. Neurological recovery was almost complete in both the cases. At6-month follow-up after surgery, both the patients were able to perform all the activities of daily living. CONCLUSION: Aggressive vertebral hemangiomas causing progressive neurological deficit should be treated with surgical decompression, stabilization, and vertebroplasty. Pre-operative angiography, embolization, and post-operative low-dose radiation therapy are recommended.